A study of immense importance

Effectively addressing mental health issues in the Caribbean is stymied by pervasive myopia and sparse economic resources. That communities and neighbourhoods are incubators for psychological problems should concern policymakers, researchers, educators, and lay persons.

Going Crazy in the City is a well-articulated offering that lays bare the social, economic, and environmental factors that raze the psyche of society's most vulnerable. Epidemiologist Jasneth Mullings and contributor Rainford Wilks present a work that has far-reaching implications for the region. Going Crazy employs every methodology to create a book of incontrovertible relevance and appeal.

The deleterious conditions of inner city life are never lost to a maze of data and academic excess. This the authors ensure. Still, given their scholastic training, they cement their narratives with a healthy dose of statistical evidence as they shift attention from one demographic to another.

Mullings identifies political policies, social factors, health services, individual behaviour and biology, and genetics as the determinants of health. She introduces social epidemiological and ecological theories alongside human settlement typology to present the interrelated, complex framework of mental health.

She writes, "The human being is recognised as an organism which is in constant interaction with the environment (physical, social) and is constantly being shaped by the environment through distinct mechanisms or pathways which can produce conditions of health or disease. What has remained a mystery for many is the identification of the specific pathways which hold the key to modifying health outcomes in the community."

Mulling's thesis

This enquiry forms the thrust of Mullings' thesis.

On depression, Mullings is unequivocal. She argues that patients are not well-served if the disorder is treated in isolation and not addressed as an integral component of chronic diseases. And citing the World Health Survey, she argues that depression is inextricably tied to cancer, diabetes mellitus, and chronic pulmonary diseases.

The authors call for a three-tiered policy response to non-communicable diseases that includes "a recognition of the social-ecological model as central to disease causation; acceptance of a chronic, care model, and improvements to the health systems that provide care for these diseases."

Living conditions, they note, are compounded by poor infrastructure, crime, unemployment, politicisation, and inter group rivalry. The essentiality of human capital, though, is demonstrated by the adaptiveness and inventiveness of many victims.

"In the Jamaica context," Mullings writes, "[i]nformal settlements are areas in which housing had emerged, but lack the requisite infrastructure such as roads, electricity and water supply," adding that with informal settlements growing at an alarming rate, urban planning and health officials are continually challenged.

She then posits that "vulnerable and marginalised groups such as the poor and persons living in adverse circumstances are at a greater risk of depressive symptoms because they experience more life stressors," and "in turn, they also experience more intense responses to these stressors, which, coupled with fewer coping skills, result in a higher exposure to psychological trauma".

'Sexual dichotomy'

There is what Mullings calls a "sexual dichotomy" in accessing resources. Of the "feminisation of neighbourhood poverty," she references female underemployment, female enterprise, female rivalry, and social relations and tensions in communities.

Going Crazy also advances that infrastructure concerns are heightened by climate variability and natural disasters in urban and rural communities, thereby demanding a deliberate proactive response at the highest political level.

Throughout, the reader never loses sight of the impact of these conditions on the psychic well-being of residents.

And while the collaborative efforts of the Jamaica Social Investment Fund and the National Waste Management Authority have had success in some communities, a gargantuan task lies ahead. Mulling sounds the alarm: "The availability and quality of the built environment are critical to the health and well-being of the community."

Going Crazy in the Neighbourhood is timely and enormously resourceful. Mullings beckons every institution to coalesce around a viable construct that addresses society's many crises, of which health is paramount.